Definition

• an open sore on an external or internal surface of the body, caused by a break in the skin or mucous membrane which fails to heal. Ulcers range from small, painful sores in the mouth to bedsores and serious lesions of the stomach or intestine

Cutaneous leishmaniasis

• Travel-acquired / worldwide cutaneous infections (PCDS). Leishmaniasis (CDC)

Leg ulcers

• A leg ulcer is a long-lasting (chronic) wound on the lower leg or foot that takes more than six weeks to heal.

  1. Venous: include pain, itching and swelling in the affected leg. There may also be other signs, such as discoloured or hardened skin around the ulcer. A venous leg ulcer is the most common type of leg ulcer, accounting for 80-85% of all cases. Venous leg ulcers develop when persistently high blood pressure in the veins of the legs (venous hypertension) causes damage to the skin, which eventually breaks down and forms an ulcer.

  2. Arterial – caused by poor blood circulation in the arteries

  3. Diabetic – caused by the high blood sugar associated with diabetes

  4. Vasculitic – associated with chronic inflammatory disorders such as rheumatoid arthritis and lupus

  5. Traumatic – caused by injury to the leg

  6. Malignant – arising from a tumour of the skin of the leg

An 85-year-old woman has a superficial, grade 1 pressure ulcer on her left heel. There is no sign of clinical infection but a routine wound swab has grown Staphylococcus aureus. Which is the SINGLE MOST appropriate treatment, according to current evidence?

1. Erythromycin tablets

2. Flucloxacillin tablets

3. Fusidic acid cream

4. Mupirocin cream

5. No antibiotic needed

NICE guidelines state to offer systemic antibiotics to adults with a pressure ulcer if there is:

• clinical evidence of systemic sepsis

• spreading cellulitis or,

• underlying osteomyelitis

Systemic antibiotics should not be initiated based only on positive wound cultures if there is no clinical evidence of infection. Topical antiseptics or antimicrobials are also not routinely recommended.

Reference

• Pressure Ulcers: prevention and management (NICE CG 179, 2014)